Five-year incidence of retinal microvascular abnormalities and its associations with arterial hypertension
WANG Shuang1, XU Liang1, JONAS Jost B2, WANG Ya-xing1, YOU Qi-sheng1, WANG Yun-song1, YANG Hua1, ZHOU Jin-qiong1, LIU Xue1
2013, 22(6):
397-404.
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Objective To describe the 5-year incidence of retinal microvascular abnormalities and analyze their associations with arterial hypertension in nondiabetic elderly Chinese subjects in urban and rural Beijing. Design Population-based cohort study. Participants 3251 subjects who had participated in the Beijing Eye Study 2001 and were returned for reexamination in the Beijing Eye Study 2006. Methods By using fundus photographs, we determined the 5-year incidence and change (progression or regression) of retinal microvascular abnormalities, including focal narrowing (FN) of retinal arterioles, arteriovenous nicking (AVN), and retinopathy. Arterial hypertension was graded as controlled treated arterial hypertension, uncontrolled treated arterial hypertension, and untreated arterial hypertension. Main Outcome Measures Incidence, worsening, and regression rate of retinal microvascular abnormalities. Results After excluding patients with diabetes mellitus or any retinal or optic nerve disease, 2058 subjects (1409 women [68.5%]) were included in the study. The mean age of subjects was 53.8±9.5 years. The 5-year accumulated incidence of FN, AVN, and retinopathy was 4.1%, 1.4%, and 3.3%, respectively. Adjusted for age, gender, and region of habitation, the 5-year incidence of FN, AVN, and retinopathy increased 1.58 times (95%CI: 1.24~2.00, P<0.001), 1.55 times (95% CI: 1.04~2.32, P=0.03), and 1.46 times (95% CI: 1.12~1.91, P=0.005) respectively for every 10 mmHg increase in mean arterial blood pressure. After adjusting for age, gender, and region of habitation, the rate of regression of FN decreased by 28% with every increase in the grade of the arterial hypertension classification. Correspondingly, the rate of regression of FN was significantly higher in the group with controlled arterial hypertension (44.4%) than in the uncontrolled (22.6%) and untreated (11.5%) groups (P=0.01). Conclusion Arterial hypertension was strongly associated with the incidence and longitudinal change of retinal microvascular abnormalities in nondiabetic subjects. Better control of arterial hypertension was correlated with a decreased incidence of retinal microvascular abnormalities and an increased regression rate of FN. This suggests that retinal FN, as potentially the first step of retinal microvascular abnormalities, is reversible if arterial hypertension is controlled.